Claim total
$704.41
base $93.83 · payer covered $554.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1975-04-10
- Stop
- 1975-04-10
The parties
- Patient
- patient Benedict Alvin Armstrong
- Provider
- provider Thomasine Balistreri
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
2c61caa8-0470-e3a1-be07-7d33e5738787